CHN on the Go

The Program

CHN on the Go (Community Health Nurses on the Go) is an Android mobile application (app) designed to motivate and support community health nurses (CHNs) who work on maternal, newborn, and child health in remote communities of Ghana. CHN on the Go was developed under the Care Community Hub (CCH) pilot project, implemented in 5 rural districts in Ghana by Grameen Foundation in partnership with Ghana Health Service, Concern Worldwide, and JSI Research and Training Institute, Inc. The design for CHN on the Go was based on formative research conducted by ThinkPlace Foundation, and guided by their human-centered design process.

Building on Ghana Health Service (GHS) guidelines and designed in consultation with nurses and their supervisors, CHN on the Go provides virtual support among peers, provides professional development opportunities, and improves communication between practitioners and their supervisors. The app includes 5 modules:

Point of Care: This module provides step-by-step instructions for antenatal and postnatal care, and care for children under five, making content and protocols easily accessible to CHNs in their daily work.

Learning Center: CHNs who work in remote communities often do not have the opportunity to attend workshops or courses. This module allows CHNs to take online courses approved by the Nursing and Midwifery Council of Ghana and earn credit towards renewing their nursing license each year.

Planner: CHNs can plan and organize their work activities and set individual targets for achievement.

Staying Well: In this module, CHNs can access tips and guidelines for how to manage their stress and workload, as well as daily readings from the Bible and the Quran.

Achievements: CHNs can monitor their progress in coursework and individual targets they have set.

In addition to these modules, there is an app for supervisors that allows them to track CHNs’ work. WhatsApp (a mobile messaging app) groups have also been established at district and sub-district levels, creating a space for dialogue among CHNs and their supervisors, to make relevant work announcements and communicate with district officials more easily.

Challenges

Similar to other mobile health (mHealth) initiatives, CHN on the Go has experienced challenges in piloting this app in Ghana:

CHN on the Go relies on the availability of smart phones, which can be expensive and limit opportunities for scaling up.

Mobile devices that are not functional in the implementation context can stall program progress and frustrate users.

Limited familiarity with smartphone technology can make it difficult for some members of the target audience to use the app.

While ultimately improving the app, regular updates can frustrate users who are not accustomed to testing new technology, and had to learn to use the new features.

Success Factors

During its 18-month pilot process, CHN on the Go discovered a number of strategies that are key to success:

Collaborating with existing initiatives that use mobile devices can make it easier to scale. In Ghana, some districts already provide smart phone devices for collecting important health data which could be supplemented with this app.

Intensive training at the beginning of the program can be used to teach users about smartphone technology and the app, and practice using it among their peers. This was especially important for supervisors and senior CHNs who were usually older and less familiar with smartphone technology.

Involving government at every level and step of the program has helped CHN on the Go to receive accreditation for its online courses and ensure sustainability of the innovation.

Involving users in the design of the app – though it can delay progress at times – can empower practitioners by showing that their ideas are valued and leads to a more useful application for the target audience. One national level official whose team was instrumental in development of the content said of the app: “This is better than what we envisioned.”

Involving the users (the CHNs) by having them present the app’s use to government officials can be both motivating and help to more effectively demonstrate the app’s use and value to key decision makers.

The use of WhatsApp can greatly benefit workers in rural areas with limited transportation resources. The app has allowed district health departments to communicate official directives, announcements for activities such as trainings and immunization drives, and to build a sense of community among all members of the district health team. WhatsApp groups are also used for group diagnosis, and, given their ability to send pictures, are a great way for nurses to receive diagnostic guidance on difficult cases.